MEDICARE: MOVEMENT FOR LIFE MASSAGE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1366295453
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOVEMENT FOR LIFE MASSAGE, LLC

Provider Business Mailing Address
First Line	:	429 KANSAS CITY ST STE 1B
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-3668
Country	:	US
Telephone Number	:	605-545-7591
Fax Number	:

Provider Business Practice Location Address
First Line	:	429 KANSAS CITY ST STE 1B
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-3668
Country	:	US
Telephone Number	:	605-545-7591
Fax Number	:	605-519-6616

Authorized Official
Title or Position	:	OWNER/MASSAGE THERAPIST
Name	:	SARAH GILES
Credential	:
Telephone Number	:	605-545-7591

Provider Enumeration Date	:	04/08/2024
Last Update Date	:	04/08/2024

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